Health Care Trends & Value Based Care

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Episode Transcript

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more at okillct dot org. Nowhere's your host for Pulse of the Region,
Kate Bowman. Hello and welcome backto another episode of Pulse of the
Region. I am your host,KATEE. Balman today recording from the iHeartMedia
Studios here in our capital city ofHartford. A great day today for a
great conversation. So today we aregetting the Pulse about value based healthcare and

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population health. We'll discuss the nationaltrends and also talk about what's happening here
in Connecticut. Very excited to introduceour two guests for the show today,
both from sone Health. First isa president and CEO, Lisa Trumbull.
So, Lisa, welcome back toPulse of the Region. Thanks for pleasure
to be here. Fantastic. Iwould say, Lisa, we may need

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to get you a co host positionhere. We've been able to have you
on several times, which I love. I would love to do that with
you. There we go. Ithink we have some good topics and today
joining Lisa is Son's Chief Population HealthOfficer, doctor George Beauregard. So doctor
Beauregard, welcome to Pulse of theRegion. Thank you're safe. It's a

(01:52):
pleasure to be here. Fantastic.Well, as I mentioned, Lisa has
been able to join us on theshow previously, but I think always great
to give a refresher about sone Health. So Lisa, if you don't mind
reminding listeners about who you are andwhat the great things you guys are doing.
Sounds great, Kate, Soonehealth ofthe New England Healthcare Organization is a

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clinically integrated network that operates in Connecticutand Massachusetts. We have five five training
health in New England hospitals and aboutseventeen hundred providers. We currently care for
over two hundred thousand patients and ourprimary role is to manage the clinical conditions,
quality and cost outcomes for the patientsthat we serve in Connecticut and Massachusetts.

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Today fantastic. I think those twokeywords, their quality and costs.
We're going to talk a lot abouttoday, But first I would love doctor
Beauregard, if you could talk alittle bit about your role as the chief
Population Health Officer. Okay, So, in my role, I am the
lead physician executives who overseas sones allpidisciplinary population health management team. That team

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consists of the number of different peoplewith various skills and expertise. People who
are ambulatory care managers who are responsiblefor managing patients who are identified at high
risk and following them along a longitudinumof care, so in the outpatient setting,

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collaborating with care managers on the inpatientside, following patients after discharge for
thirty days, Following people who arein skilled nursing facilities. We also have
behavioral health care managers. We haveclinical pharmacists, we have care managers who

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special expertise in certain chronic illnesses.We have quality improvement folks, we have
risk adjustment people, community health workers, and others. And we're also in
the early stages of incorporating activities adjustingsocial determinants of health and health equity.

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So a very busy day to day, doctor Beauregard. Is that correct to
say? Definitely? No. Well, and before we kind of dive into
the conversation today, you know,I kind of wanted to touch on a
couple of buzzwords and this, Lisa, is something you know we've talked about
in the past. But you know, really when we talk about value based
healthcare and we talk about population healthis there's a lot of words that I

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think sometimes we have many definitions behindthem. So you know, first,
I think first as we hear Mthe term value based care, and I
know through conversations there is confusion aboutwhat this potentially could mean, So I
want to kind of set it straightto start things off, is could you
give us a definition of value basedcare? Absolutely? I think healthcare as

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an industry is very good at buzzwordsand acronyms that add a level lexity that
is unnecessary. But what value basedcare is is the organization of providers that
are accountable for the outcomes of thepatients that they care for, and that
accountability is focused on costs, umand quality and efficiency. So the you

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know, the cost is uh,you know, the care that we're providing
to our our our patients. Canwe organize it in a way that's more
cost effective? Can we prevent conditionsfrom worsening and becoming more costly? You
know? And this cost is costlyto the patients. That's it's costly to
our society, it's costly to employers. And so when we look at costs,

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we look at the entirety of thecosts of care provided to the patients
that we serve. And then qualityand the outcomes for patients relative to quality,
which crosses to many domains. Youknow, how are there if they're
diabetic, how their diabetes being managed, If they're admitted to a hospital,
are they having readmissions and infections?And if they're amitted to a sniff or

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they're readmitted to a hospital. Youknow, all those activities become an aspect
of quality that also adds more costsand creates more efficiency in the system.
And in terms of efficiency, we'relooking at our you know, are we
receiving care that's really unnecessary or duplicateor duplicative and because all of those increase

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the cost and have an opportunity tofragment the quality of care that's provided to
our patients. So when we're talkingabout value based care, it's really cost
quality efficiency. And then I wouldadd service into that mix. You know,
are you getting the appropriate service?Are you happy with the service that
you're receiving? Fantastic, Lisa,thanks so much for that. And the

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other you know, kind of buzzwordI want to touch on is population health,
and doctor Beauregard, if could youcould give us a little bit of
a background about what population health isand really what does it mean. So
Lisa touched on you know, manyof the aspects of it, but strictly
defined, population health refers to thehealth outcomes are the defined group of individuals.

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So either you know, the enrolleesand a particular insurance plan, Medicare,
beneficiaries, etc. And so wherethe health outcomes of that defined group,
including the distribution of those outcomes withinthe group. So the healthcare delivery

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perspective, population health means, asLisa mentioned, that health physicians and hospitals
are being held accountable for the clinicaland financial outcomes of that defined cohort of
patients. And that's different from communityhealth, where I think there's a lot

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of confusion about population health and communityhealth. We're not accountable for the outcomes
of community health. It's our jobto support it. But in population health,
we are accountable for the outcomes.Very another piece, the other piece
I'll mention is that population health ismore is morphing into something that's more proactive

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instead of reactive. Okay, soyou know, if all we do is
fix people who break, you know, we're never going to solve the healthcare
you know, crisis that exists inthe country. So we've got to get
upstream of many of these people andhave initiatives that retard the progression of their
disease, identify risk factors, makesure they get their cancer screenings, you

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know, etc. Etc. Excellentpoints there, and you know, as
you mentioned, kind of looking athow do we work farther upstream to start
this is really something that's happening ona national level, and then additionally to
really happening here in Connecticut. SoLisa, why don't we first start with
the national view and if you couldtalk a little bit just on kind of
what's happening in this space across thecountry. I think it's an interesting time

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to be in the healthcare industry.The industry. It could be scary to
some people, it can be excitingto others. It's exciting to me to
think that there's so much opportunity forchange in a way we deliver healthcare,
and a lot of that is drivenby a cliff that order to face.
Nationally. By twenty thirty, we'regoing to have another fifty percent of our

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aging population agents and medicare. Thataging into medicare comes generally with more acute
need for healthcare services and more costsassociated with acuteness of need. It's coming
at a time also where workforce,the workforce in the healthcare industry starting to

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decline, when we're anticipated to losea significant amount of individual to retirement,
you know, on their own andothers that are quite frankly after the pandemic
leaving the healthcare industry, and thenso a couple increasing demand with decreasing supply
of those able to address that demand, which sends results in increasing costs to

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the point where it's projected that twentypercent of the GDP, the GDP will
be healthcare will be excusing healthcare willbe twenty percent of the GDP by twenty
thirty. So, you know,so nationally we're looking at this and saying
we have to do something, andit's really hard to address it nationally because

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it really requires some political willpower totry to address this. So we look
at locally, how do we howcan we address it here in Connecticut,
and value based care is one ofthe ways that it can be addressed.
You know, it's an incremental approachand often takes a period of time to

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be able to impact the help andhealth outcomes and cost outcomes of a population
that you're managing, but it isone way to approach managing the situation.
The other way is to look atare there places where and we're seeing this
in Connecticut ourselves, where the healthcaresystems can be somewhat disrupted with new players

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that come into the market that canoffer a different way to approach healthcare,
and we're seeing that with more servicesthat are moving basically from a hospital setting
to a non hospital setting like infusionsand anbulatory surgery and things like that,
and many of those activities reduce thecosts over time. They may not address

(11:54):
the utilization issues or needs, butthey do address the costs of services that
are provided in the hospital setting versusthose that are provided in the non hospital
setting. Okay, and Lisa,could you talk a little bit more about
this disruption kind of happening in Connecticutand who are some of the you know,
the other players that are really,you know, kind of pushing towards
this disruption, And I mean disruptionin a good way. The disruption is

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you know, I do believe thatthe disruption is in a good way.
One of the situation that we're seeingin Connecticut at the moment is that Connecticut
is a high healthcare spend state.Massachusetts had been in a similar situation many
years ago, and they put ina number of policy changes similar to what

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Governor Lamont is doing here with thecost growth benchmark in various other activities through
the Office of Health Strategies. Butyou know, the disruptors are seeing so
distructors in terms of private equity,capital, venture other types of healthcare structures
that they are looking Connecticut as anopportunity to uh to to basically earn a

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return on on disrupting healthcare and changingthe flow of healthcare. And even though
they earn a return, there's apotential with the earning of a return on
that business model to actually lower healthcarecosts in the long run. So we
see we see things like the youknow, the one medical Relationship, the
you know, the previous of theworld and um you know, optum and

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other entities that are looking to dosomething similar. It's no different really than
what Zone is trying to do.It's just they tend to be more um
backed by health equity or by privateequity and venture capital dollars that are not
you know, locally local investments orinvestments provided by local okay um entities.

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Okay, understood. And now allof this is often coupled with a focus
on population health and doctor Beauregard,you know, really, when it comes
to population health, could you talka little bit, you know, and
piggybacking off of Lisa and really,what are we seeing here in Connecticut.
Well, I think that there's youknow, a wide variation in what's going

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on in different places in Connecticut,ranging from you organizations who are probably still
standing on the sidelines and waiting tosee if all this is going to stick,
which you know, by all indicationsthat certainly the direction CNS appears to
be going in. There are otherorganizations that are probably just dabbling at the

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edges, and in particular, oneexample could be employers who are self insured
are starting to put in programs tomanage their own employees to a better state
of health, you know, lessabsenteeism, give them incentives for you know,
rewarding healthy behaviors, you know.So that's two. And there are

(15:01):
other organized systems like son and otherorganized delivery systems in Connecticut that are actively
participating in accountable care arrangement programs,either with the centers for Medicaid and Medicare
services or the commercial players or theMedicare advantage players. So I think there's

(15:26):
a there's a spectrum of what's goingon in Connecticut. And to Lesa's point
earlier, both of us have abackground in Massachusetts where the cost control of
healthcare expenditures, and Massachusetts, youknow, they started very significant efforts back
in two thousands addressing it and youknow, with some good results today Sneticut's

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a little behind, okay, butcertainly opportunities to get there and and certainly
too I think a lot of it. And at least so we've talked about
this before, but as we lookat employers, is employers can play a
large role, you know, kindof in everything we've been discussing today.
And so really from your perspective,is what should employers be looking for as
they go into reviewing health plan options, you know, with a goal of

(16:15):
really looking at implementing a population managedmodel. I think it's a great question,
Kate. You know, I wasin a meeting recently where someone shared
a statistics with a statistic with meand I'm assuming it's correct at forty percent
of the residents in Connecticut do nothave a primary care provider. Wow.
You know if that, if that'strue, then you're not receiving the right

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level of care that you should bereceiving for yourself. You're not being proactive
in your care. And therefore,if you do have issues or conditions that
need attention, you're certainly not gettinginto an entity like ours that has a
population framework that could be helpful toyou, and that a long run is
going to cost you more money outof your pocket, it's going to cost

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your employer more money, and it'sgoing to cost society more money. And
so I think the one thing employerscould do in the marketplace today is require
primary care. And I know there'sa lot of reluctance to do this because
of the nineties, when you know, it was an ugly thing to have
a primary care provider because it wasperceived as a gatekeeper. But that's not

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the case. The primary care providersyour advocate in your healthcare, and if
you don't have an advocate for you, then you end up navigating the system
entirely on your own. You haveto figure out who the best providers are,
who are the high quality providers arethe entities where you're going to get
efficient, cost effective, high qualitycare. You have to do that all

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on your own, and this iswhere primary care can be extremely helpful.
So I would say the first thingis to at least start with requiring a
primary care provider. Perfect and Ithink it was great in one of the
prep calls that we had, doctorBeauregard, you referred to the primary care
provider as really the patient's quarterback.And you know, would love if you

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could give your perspective too on justyou know, why is it so important?
Into addition to addition, oh,in addition, there we go to
what Lisa said is really, youknow, why is it important to have
this PCP and really this quarterback forindividuals? Well, you know, okay,
I'm an internal medicine DOCTA training,so you know, I sort of
was about quote unquote quarterback for manyyears. Okay, there we asked the

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pas. But the primary care physitionis really the keystone to a person realizing
care that's high quality, comprehensive,coordinated. You know, having that primary
care physition is essential helping a personnavigate to good health and maintaining that preventing

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disease, early identification of risk factors, coordinating and managing chronic illness care and
with photos to high value specialists forlongevity and a better quality of life.
And they also serve as the centralfigure in understanding the patient's beliefs and values.

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Let me know the family dynamics,you know, so I truly believe
they are the quarterback. And Ithink frankly, primary care has been undervalued
for a long time, and Ithink if that dynamic is starting to change,
great now. Thank you for thosepoints. And one thing I want
to go back to is, Lisa, you touched on that there's a decline

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in the healthcare workforce and you knowthat also does include with PCPs. So
could you talk a little bit justabout this decline and you know, how
can we as a business and ahealthcare community really address the critical need for
healthcare workers. Yeah, there certainlyis a significant decline anticipated with providers as

(20:00):
as nursing. So I think ina population health model, nursing is incredibly
important. A primary care provider needsa team around them, and that team
incorporates nurses and medical assistance and youknow, pharmacists and others that can help
lessen the burden that is on theprimary care for managing their care. But

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the decline and the workforce is absolutelyreally acute. We have less and less
individuals seeking healthcare as an alternative fora career paths. So we need to
make that attractive. And in Connecticut, we need to make it easy to
be a provider in the state ofConnecticut. What recruiting capabilities can stay to

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Connecticut provide healthcare systems and practices.In terms of making it attractive to bring
physicians and other healthcare talent to thestate. I think we really need to
look at that. Are their loanforgiveness programs that could be put in place.
Are there administrative burden reductions that thestate could take as an initiative to

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lessen the burden of all of theadministrative requirements that healthcare providers have on them
today that would make it more Connecticutmore attractive than other states. So I
think that there's a lot that canbe done. You know, there's a
focus that could be put on usthat it's you know, it's Connecticut's a
great place to live as a highquality of life. You know, we

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can we can structure it to reducethe burden for providers to practice here.
We can maybe have incubation models tostart up primary care practices, you know,
because starting up a practice on yourown is an overwhelming task. And
I know one of the issues thatwe deal with in our network is the

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aging workforce of the primary care providersin our existing practice and the cause so
that it takes to replenish, okay, those aging aging providers in the between
the uh, you know, thecompetitiveness of the recruitment process. You know,
the cost to bring to recruit someoneon board, them, relocate them

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and get them established in the practicesis pretty significant. And for small practices
or independent practices or any practice.Quite frankly, it's it's a it's a
it's a costly endeavored to do this, and it's one of the barriers to
being able to replenish the primary careprovider workforce in our state. Okay,

(22:37):
now, a lot of again,very good points there, Lisa, so
thank you for sharing that. Andthe last kind of section of the show
is I really do want to touchon on cost overall, not necessarily focused
on the workforce, but just reallyon value based care and what can the
cost savings potentially be. And youknow, doctor Beauregard is really from your
vantage point, is how great ofan impact can value based care have on

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reducing you know, unnecessarily utilization ofservices which relate at the end of the
day, then is cost savings.Do you talk a little bit about that?
Sure, you know there are manybut there's anecdotal evidence obviously that this
type of population health management works,But there are also many public studies that

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do indeed demonstrate reductions in the utilizationof lab testing, certain advanced imaging tests
like MRIs and cat scans, emergencydepartment visits, hospital admissions, readmissions,
etc. And you know, reducingall of those too what I'll described as

(23:42):
an appropriate level based on the illnessburden of the population is going to result
in lower costs, you know,and better patient outcomes. You know,
I'd do remiss if I didn't mentionthat in those studies, not only were
the cost reductions, but there wereimprovements in the measure of quality and that's

(24:04):
the real definition of value and healthcareget or outcomes at a lower cost.
And Lisa and anything else you'd liketo chime in with their in regards to
you know, really the cost impact. You know, I think when we
look at the major cost categories UM, carreo, metabolic conditions, cancer,

(24:29):
diabetes, and you know, thoseare all major categories where were costs tends
to accelerate as conditions worsen. Butthe one that I think is is the
one that's the most frustrating and umand there's a relatively low ability to actually
manage a certain range of costs inthe pharmaceutical UM area of the spend.

(24:55):
We get more and more new technology, some of them are really cost play
to deploy. And what I foundover the years is that when looking at
the cost of the populations that we'remanaging, you know, we can we
can manage conditions to avoid an admission, to avoid UM, you know,
certain services that are are unnecessary orwe could prevent even needing those services.

(25:19):
But at times that gets overshadowed bythe spend and the pharmaceutical UM aspect of
the of our work. And alot of this is you know, new
technology, new drugs, price increasesand that are you know, out of
control and need some level of intervention, but the intervention unfortunately has to be

(25:42):
nationally perfect. Well, Lisa,thank you so much. And where can
people go to you know, learnmore information? And also is there any
kind of upcoming events happening with sonHealth Yes, that would be SOUN Healthcare
dot com. You can see whatour organization is. Our biowns access the

(26:03):
primary care provider or specialists or understandwhere to get healthcare services at one of
our hospitals. We made a primarycare provider or specialist. We have all
of that available on our website newimmediate events at the moment, but certainly
we'll keep you posted on anything thatwould be coming up. Fantastic. Well,
thank you so much for that,And we have about a minute or

(26:25):
so left, so if you don'tmind, I'm going to put you both
in the hot seat when we everwe have time. We love to ask
the question is what do you eachlove most about visiting and or working here
in the Hartford region. So whynot doctor Beauregard, If you don't mind,
I'll put you on the hot seatwith that one first. Good lucky
you. Well, you know,I've had the fortune of working in various

(26:47):
markets across the country, and allof them are at different stages of doing
this kind of work, and sowell, what I have found so far
today in the Hardcore region is thatyou've got a very committed healthcare work for
people who are very passionate and verydedicated to improving you know, the outcome
for the patients. And you know, you know, we know what these

(27:10):
healthcare workers have gone through over thelast three to four years, and they're
undeterred, and you know that's avery rewarding part of this job. Fantastic,
I love it. We always getnew answers, which is which is
great to hear and Lisa, withoutstealing doctor Beauregards, what would be your
answer and what you love most aboutwhich I know it's tough to go second.

(27:32):
That's right, that's right. I'mgoing to take a non healthcare approach.
There we go, yukon basketball andthe restaurant experience in Hartford. Um,
you know today all both great experiencesand I enjoyed it very much.
My time at Hartford fantastic. Iagree with both answers, all three of
the answers, So thank you bothfor being on the show today. Really

(27:52):
appreciate the conversation and you know,really look forward forward to continuing the conversation
as we look ahead too. Kateis always thank you for having us,
of course pleasure. Chase, thankyou very much of course. And as
I look to close out the showtoday. Before doing so, I would
like to welcome a new investor tothe MHA. We refer to our members

(28:14):
as investors because they're investing in thework we're doing to promote and grow the
region. So today we welcome BalletHartford. Founded in two thousand and sixteen,
Ballet Hartford is Hartford's professional ballet companycommitted to promoting art that is full
of the true, the good,and the beautiful. A vibrant company comprised
of high caliber dancers from across America, their aim is to impact the greater

(28:37):
Hartford region through engaging performance series,educational programming, festivals, and outreach.
For more information, you can visitBallet Hartford dot com. For all the
details about today's show, you canvisit Metro Hartford dot com. We'd like
to say thank you as always toour partner Oak Hill, and thanks for
you to you for listening. I'mKate Ballman. Go out and make today

(28:59):
a good day here in Connecticut because